Age-Related Differences in Characteristics, Performance Measures, Treatment Trends, and Outcomes in Patients With Ischemic Stroke
Age-Related Differences in Characteristics, Performance Measures, Treatment Trends, and Outcomes in Patients With Ischemic Stroke
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DOI：
10.1161/circulationaha.109.892497
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发表时间：
2010-02-23
期刊：
影响因子：
37.8
通讯作者：
Schwamm, Lee H.
中科院分区：
文献类型：
--
作者：
Fonarow, Gregg C.;Reeves, Mathew J.;Schwamm, Lee H.
背景 - 先前的研究表明，老年患者指南推荐治疗的使用率较低，卒中后结局更差。我们试图在一个大型当代队列中检查急性缺血性中风的特征、表现测量、时间趋势和早期临床结果方面与年龄相关的差异。方法和结果——对 2003 年至 2009 年 Get With theGuidelines-Stroke 项目中来自 1256 家医院的 502 036 例缺血性中风入院患者进行分析。数据按年龄组（= 90 岁）和以年龄作为连续变量。分析了 7 个预定义的绩效指标和 2 个汇总指标。缺血性中风患者的平均年龄为71.0+/-14.6岁； 52.5%是女性。老年患者更有可能有房颤或高血压病史，黑人、西班牙裔或当前/近期吸烟者的可能性较小。尽管每个个体的表现指标都存在一定程度的与年龄相关的差异，但从 2003 年到 2009 年，每个年龄组的表现指标都出现了实质性的改善，并且许多与年龄相关的治疗差距随着时间的推移而缩小或消除。年龄每增加 10 岁，老年患者出院回家的可能性较小（调整后比值比为 0.69；95% 置信区间为 0.68 至 0.69），且在医院死亡的可能性更大（调整后比值比为 1.27；95% 置信区间为 1.25 至 1.29）。结论：老年缺血性卒中患者的临床特征不同，院内死亡率高于老年患者。年轻的患者。随着时间的推移，所有年龄段的缺血性卒中患者的基于表现测量的治疗率均大幅提高，从而缩小了与年龄相关的治疗差距。 （流通。2010 年；121：879-891。）
Background-Prior studies have suggested lower use of guideline-recommended therapy and worse poststroke outcomes in older patients. We sought to examine age-related differences in characteristics, performance measures, temporal trends, and early clinical outcomes for acute ischemic stroke in a large contemporary cohort.Methods and Results-The relationships between age and clinical characteristics, performance measures, and in-hospital outcomes were analyzed in 502 036 ischemic stroke admissions from 1256 hospitals in the Get With the Guidelines-Stroke program from 2003 to 2009. Data were analyzed by age groups (= 90 years) and with age as a continuous variable. Seven predefined performance measures and 2 summary measures were analyzed. Mean age of ischemic stroke patients was 71.0+/-14.6 years; 52.5% were women. Older patients were more likely to have a history of atrial fibrillation or hypertension and less likely to be black, Hispanic, or current/recent smokers. Although modest age-related differences in each individual performance measure were identified, there were substantial temporal improvements in performance measures from 2003 to 2009 in each age group, and many age-related treatment gaps were narrowed or eliminated over time. Older patients were less likely to be discharged home (adjusted odds ratio, 0.69; 95% confidence interval, 0.68 to 0.69) and more likely to die in hospital (adjusted odds ratio, 1.27; 95% confidence interval, 1.25 to 1.29) for each 10-year age increase.Conclusions-Older patients with ischemic stroke differ in clinical characteristics and experience higher in-hospital mortality than younger patients. Performance measure-based treatment rates improved substantially over time for ischemic stroke patients in all age groups, resulting in smaller age-related treatment gaps. (Circulation. 2010; 121:879-891.)